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Virtual Microscopy: Express Surgical Pathology Consultation · Virtual Microscopy – Prime Time...
Transcript of Virtual Microscopy: Express Surgical Pathology Consultation · Virtual Microscopy – Prime Time...
Mercè Jordà, University of Miami, Florida
Virtual Microscopy:
Express Surgical Pathology
Consultation
Telepathology versus
Virtual microscopy (Digital Pathology)
Telepathology
Use of telecommunications technology
to share real-time pathology images
between two or more locations Frozen Section
Internal Consultation
Second opinion
First cancer diagnosis
QA in surgical pathology
External Consultation
Digital Pathology
It is an image-based environment
that enables the acquisition,
management and interpretation of
anatomic pathology information
generated from a digitized glass
slide obtained through whole slide
scanning, also called “virtual
microscopy”
Virtual Microscopy
Use of computer technology to convert
analog microscopic images into digital
images
Whole slide imaging, digital imaging,
virtual slides, virtual microscopy
Real-time usage is optional
Virtual Microscopy Ingredients
Microscope
Camera
Scanner
Computer
Monitor
Software
Internet connection
And of course, glass slides!
Virtual Microscopy: Ingredients
Mechanical
scanner
Light source
Imaging optics
Digital
image
sensor
Image
processed
with
software
Computer
display
Image files
(computer data)
Conventional
optical microscope
Virtual Microscopy: Solutions
Virtual Microscopy: Applications
Primary Diagnosis (?)
Education
Research
Image analysis
Archival and retrieval
laboratory information system
Secondary diagnostic consultations and
virtual slide sharing J Digit Imaging. Jan 29, 2013.
Virtual Microscopy: Legal Status
Federal Drug Administration (FDA)
evaluated DP
Safety and cost effectiveness were
compared with conventional light
microscopy
Up to date, FDA has not yet approved
DP for routine first line AP diagnosis to
replace conventional light microscopy..
J Pathol Inform. 2: 36, 2011
From Limitations to Solutions in the USA
Lack of FDA approval for use
as primary diagnostic tool
Multi-Center Clinical Trials
Subsequent mass adoption
Virtual Microscopy: Legal Status
Many vendors are currently looking
into different market economies,
such as Europe, where health
policies are looser and better
integrated.
U.S. government takes a more
incremental approach to health
policies than European countries.
Virtual Microscopy – Prime Time
http://www.labmedica.com/lab_technology/articles/294738658/pathology_labs_replace_microsco
pes_with_digital_imaging.html
Pathology Labs
Replace
Microscopes
with
Digital Imaging
Virtual Microscopy – Prime Time
Microscopes are being replaced with
digital imaging in southern Sweden
The system will be possibly the largest
and among the first of its kind in the
world
New workflow management system will
manage both the preanalytical and
analytical stages
http://www.labmedica.com/lab_technology/articles/294738658/pathology_labs_replace_microscopes_with_digital_imaging.html
Virtual Microscopy – Prime Time
4 laboratories
400,000 glass slides / year
14 total scanners
Real-time status of each sample, slide,
and case
Digital slides stored remotely in Japan
in multiple locations (increased
security) for at least 20 years
http://www.labmedica.com/lab_technology/articles/294738658/pathology_labs_replace_microscopes_with_digital_imaging.html
Virtual Microscopy – Prime Time
Real-time status of each
sample, slide, and case
Digital slides stored remotely
in Japan in multiple locations
(increased security) for at
least 20 years http://www.labmedica.com/lab_technology/articles/294738658/pathology_labs_replace_microscopes_with_digital_imaging.html
Virtual Microscopy
Many studies assessing reproducibility when
using WSI versus conventional microscopy
Results are showing that virtual slides are as
useful as conventional slides for diagnosis
Differences are presumed to be due to the
pathologists’ lack of experience using the
virtual microscope.
Arch Pathol Lab Med, 137: 518-524, 2013
APMIS, 120: 298-304, 2011
Seminars in Diag Path 27, 160-166, 2010
Human Pathology. 41, 1770–1776, 2010
J Pathol Inform. 1: 16, 2010
Semin Diagn Pathol Nov;26(4):165-76, 2009.
Is Virtual Microscopy Ready For The Prime Time?
A Comparison With Conventional Microscopy
C Reyes, M Nadji, O Ikpatt, R Cote
Histologic diagnoses of breast core biopsies compared between
CM and WSI
Virtual Microscopy – Breast Core Bx
Aim To investigate the possibility of whole
slide imaging being used for first line diagnoses of breast core biopsies
Materials and Methods 103 needle breast biopsies Each slide was scanned at 20X Three pathologists 1st CM WSI 2nd CM
Virtual Microscopy – Breast Core Bx
Diagnostic categories included: FCC with or without DH ADH DCIS IDC
The intra-pathologist reproducibility was recorded for CM vs WSI
Variation between the first CM and the second CM was used as control
Slide Review (CM # 1)
Slide Review (CM # 2) Whole Slide Image (WSI)
CM vs CM CM vs VM
Intra-Observer Agreement
1 week 1 week
Virtual Microscopy – Breast Core Bx
P # 1 P # 2 P # 3
1st CM vs WSI 1% 4% 1%
1st CM vs 2nd CM
4% 7% 9%
p value < 0.3
Virtual Microscopy – Breast Core Bx
All intra-pathologist diagnostic disagreements (CM vs CM and CM vs WSI) were DH and ADH
There were no intra-observer disagreements in the diagnosis of benign versus malignant disease
Virtual Microscopy – Breast Core Bx
The intra-observer variability in the dx of breast core biopsies by WSI is at least same as CM
WSI could replace CM in the diagnosis
of breast core biopsies
Validation of Whole Slide Imaging For First Line Diagnosis
Of Prostate Biopsies J Zeitouni, M Jorda, C Reyes, M Nadji
Histologic diagnoses of prostate core biopsies
compared between CM and WSI
Virtual Microscopy – Prostate Core Bx
Aim To investigate the possibility of whole
slide imaging being used for first line diagnoses of breast core biopsies
Materials and Methods 103 needle breast biopsies Each slide was scanned at 20X Three pathologists 1st CM WSI 2nd CM
Virtual Microscopy – Prostate Core Bx
Diagnostic categories included: BPT HGPIN PCa Gleason 6 PCa Gleason 7 PCa Gleason >7
The intra-pathologist reproducibility was recorded for CM vs WSI
Variation between the first CM and the second CM was used as control
Slide Review (CM # 1)
Slide Review (CM # 2) Whole Slide Image (WSI)
CM vs CM CM vs VM
Intra-Observer Agreement
1 week 1 week
Virtual Microscopy – Prostate Core Bx
P # 1 P # 2 P # 3 P # 4
1st CM vs WSI 2% 3% 2% 2%
1st CM vs 2nd CM 2% 1% 3% 3%
p value < 0.3
Virtual Microscopy – Prostate Core Bx
All intra-pathologist diagnostic disagreements (CM vs CM and CM vs WSI) were between Gleason grades 6 and 7
There were no intra-observer disagreements in the diagnosis of benign versus malignant disease or for the Gleason >7 category
Virtual Microscopy – Prostate Core Bx
The intra-observer variability in the diagnosis of prostate biopsies by whole slide imaging (WSI) is the same as glass slide microscopy.
Our results suggest that WSI could be used
as an alternative to CM for the first line diagnosis of prostate core biopsies.
In sum, UM message…..
Our results suggest that…..
WSI could be used as an alternative to CM for first line diagnosis breast & prostate
core biopsies
“Virtual microscopy does not compromise, but might improve, the accuracy of grading in prostate needle biopsies.”
Virtual Microscopy: Education
Virtual Microscopy – Clinical Trials
Neptune: Use of Virtual Microscopy
Virtual Microscopy
Wider adoption of WSI will
require
full integration with the LIS
continuous automated
scanning
high-large storage capacity
interfaces.
Virtual Microscopy: Other than 1st line diagnosis
case consultation
legal cases
multidisciplinary conferences
can also assist in keeping
records of slides to be sent out
or destroyed by ancillary testing
J Pathol Inform. 1: 16, 2010.
Poses multiple controversial issues:
Licensing
Liability
Security
Reimbursement
Scanning quality and its validation.
Regulations and standardization are not yet in place
J Digit Imaging. Jan 29, 2013.
Controversies of Virtual Microscopy Consultation Services
Network connectivity and firewall
configurations when linking two
separate organizations
Information technology regulations
for each organization
Major Challenges
Controversies of Virtual Microscopy Consultation Services
occasional user: asynchronous upload is recommended
custom/client telepathology portal with capacity of large volume
imaging streaming method: provides real-time
consultation
Disadvantages
• implementation cost is higher
• requires high level of connectivity between original and consulted
institution
Solutions vary in type of user…..
Controversies of Virtual Microscopy Consultation Services
Facilitates rapid, efficient
communication between subspecialty
pathologists and generalist pathologists
2nd opinion on challenging cases
Fine-tuning of diagnostic interpretation
Advantages of Virtual Microscopy Consultation Services
Overnight shipping/mailing charges/costs can be avoided
loss of slides and international costumes for
transferring human tissues are not anymore a
concern
Results are delivered via secure website, which
expedite consultation response improving client’s
satisfaction and patient treatment.
Potentially faster patient diagnosis and treatment decreasing healthcare cost
Advantages of Virtual Microscopy Consultation Services
Advantages of Virtual Microscopy
Data can be encrypted for
online transmission via “https”
(Hypertext Transfer Protocol
Secure)
HIPAA guidelines are adhered
to by receiving institution
Advantages of Virtual Microscopy
Variety of virtual microscopy image formats currently utilized: *.jp2 *.svs *.vms *.vmu *.mrxs *.ndpi
Virtual Microscopy and File Upload Time
File upload time is dependent on file
size and internet connection speed
Most institutions have “high-speed”
internet connections
Virtual Pathology Consultative Services